Opioid Use in Older COPD Patients Can Worsen Prognosis

Treating older adults with chronic obstructive pulmonary disease (COPD) with opioids may not be the best idea. Researchers at St. Michael’s Hospital, in Toronto, Canada, have shown that new opioid users have up to five times higher risk of death than non-opioid users.

The findings were published recently in the European Respiratory Journal, in the study “Incident opioid drug use and adverse respiratory outcomes among older adults with COPD.”

COPD patients may be prescribed opioids such as codeine, oxycodone, and morphine, for common COPD symptoms including muscoskeletal pain, insomnia, and respiratory issues — but opioids can induce additional respiratory side effects in patients.

“This is a population that has a chronic lung disease, with symptoms that can sometimes be challenging to manage,” said Dr. Nicholas Vozoris, a respirologist at St. Michael’s and lead author of the study, in a press release. “This class of drugs may offer some relief; however, there is also evidence suggesting that opioids can adversely affect breathing and lung health in people who already have chronically compromised lungs.”

Although several clinical trials have reported that opioids are safe for patients with advanced COPD, the results cannot be generalized because of study limitations.

For the new study, researchers examined records of 130,979 COPD patients in Ontario, aged 66 or older. Between April 1, 2007, and March 31, 2012, 68.2% of the patients had received an opioid prescription. The data were obtained from multiple provincial healthcare administrative databases at the Institute for Clinical Evaluative Sciences.

“Previous research has shown about three-quarters of older adults with COPD have been prescribed opioids, which is an incredibly high rate of new use in a population that is potentially more sensitive to narcotics,” Vozoris said. “Our new findings show there are not only increased risks for respiratory-related death associated with new opioid use, but also increased risk of visits to emergency rooms, hospitalizations and needing antibiotics or steroid pills.”

The team found that opioid users had a 14% increased risk of emergency room visits for COPD or pneumonia; 2.16 times an increase in COPD or pneumonia-related mortality; and a 76% higher overall mortality risk. However, opioids significantly decreased outpatient respiratory exacerbations in 12% of cases.

Although the higher risks were seen in patients taking more potent or higher dosage opioids, new opioid users were seen to have increased risks regardless of the dose prescribed.

“Sometimes patients are looking for a quick fix for chronic pain or breathing issues and physicians may believe opioids can offer them some relief,” he added. “The trade-off becomes explaining that there are risks to patients and making sure they understand that potentially alleviating their symptoms could come at a higher cost to their health.”